Application for Employment

Equal Opportunity Employer

Personal Information

First Name

Middle Name

Last Name

Home Phone

Mobile Phone

Email Address

Country

Address

City, State/Province

Birthdate

Are you a U.S. citizen?

NoYes

Are you authorized to work in the U.S.?

NoYes

Have you ever been convicted of a felony?

NoYes

Have you served in the U.S. military?

NoYes

U.S. Military Service Details (branch, specialties, rank, etc.)

Special Skills, Training, or Certifications

Objective

Preferred Start Date

Desired Pay

Positions

Accounts Payable/ Receiveable

AR/ AP

Customer Service Representative (CSR)

Disassembly Technician

Electronic Assembler

Forklift Operator

Fuel / Lube Tech

High-reach Forklift

Industrial Plant Mechanic

Maintenance Laborer I

Quality Assurance Inspector

Re-Work Technician

Receptionist

Recruiter

Sales

telemarking

Warehouse

Warehouse Clean-up Associate

Locations

Roseville, CA (Main Office)
755 Sunrise Blvd.
Suite 150
Roseville, California, US

Education

Add at least 1 school.

School Name	Location	From	To	Degree	Options

+ Add School

Employment

Add at least 1 employer.

Name	Address	From	To	Position	Responsibilities	Supervisor	Reason for Leaving	Okay to Contact	Options

+ Add Employer

References

Add at least 1 professional reference.

Name	Address	Phone	Email	Relationship	Occupation	Options

+ Add Reference

Upload Resume

Please attached file with your resume.

No file attached.

How did you hear about Direct Placements?

Middle Name

(if none, type none)

Were you referred?

If yes, please provide the name of the person who referred you.

Social Security Number

Emergency Contact

Enter the name, relationship and phone number of your emergency contact.

Are you a veteran and a member of a family that received Food Stamps for a peroid of the last 3 months in the last 15 months?

Yes

Emergency Contact Phone Number:

Are you a member of a family that received AFDC (TANF) benefits for any 9 months in the last 18 months?

Yes

Are you a member of a family that received Foot Stamps for the last 6 months? Or for at least a 3 month period within the last 5 months, BUT is no longer receiving them?

Yes

In the past year has been convicted of a felony or released from prison after a felony conviction?

Yes

Date of Conviction & Date of Release

If does not apply, please type in "N/A".

Total income for the past 6 months prior to hire date for all family members living in the same household. In no income, enter 0.

Number of family members living in the same household for 6 months prior to hire date, including yourself.

Lives and plans to continue living in a Federal Empowerment Zone, Enterprise or Renewal Community?

Yes

Received Supplemental Security Income (SSI) benefits for any month ending within the last 60 days?

Yes

Is a member of a family that has received TANF payments for at least 18 consecutive months?

Yes

Has received/is receiving TANF payments for any 18 months starting after August 5, 1997 and the earliest 18 month period beginning after August 5, 1997 ended within the last 2 years?

Yes

Has stopped being eligible for TANF payments within the last 2 years because of Federal or State Law limited the maximum time those payments could be made?

Yes

I, the undersigned, do hereby authorize Direct Placements to examine any and all criminal records and arrests on file in the counties in the State of California or any other state. In doing so, I understand that I am waiving my right of confidentiality concerning my criminal history.

Type full name to sign.

I hereby authorize and give full permission to have Direct Placements and or their medical company physician send a specimen of my urine and/or blood to a laboratory for screening using S.A.M.H.S.A. standards for the presence of illegal drugs, alcohol, or prescription medication taken without a prescription.
I will hold all parties concerned harmless, meaning I will no sue nor hold responsible for any alleged harm to me or interfering with my obtaining a job or continuing employment due to not submitting to the tests or as a result of report of the test. This includes, but not limited to, possible clerical or laboratory error.
This policy and authorization has been emplained to me in a language I understand and told any questions that I have about the test will be answered. I understand this is a legal and binding document which is biding because this staffing agency is sending me for the exam and paying for it.

I UNDERSTAND THAT DIRECT COMMUNICATION WILL REQUIRE A DRUG SCREEN TEST WHENEVER AN "ON THE JOB" ACCIDENT IS REPORTED IN ACCORDANCE WITH DIRECT PLACEMENT'S INJURY POLICY AND THIS IS MY AUTHORIZATION AND CONSENT. MY REFUSAL TO SUBMIT TO DRUG TESTING WILL BE GROUNDS FOR TERMINATION.

Type full name to sign.

I authorize the investigation of all statements contained in this application. I understand that falsification, misrepresentation or omission of facts will be cause for immediate dismissal or removal of my application from consideration. I authorize Direct Placements to secure background information about my background and experience other employers, educational institutions, references and governmental agencies, and for those parties to provide information concerning my background and experience. I release all parties from any parties from any liability arising there from. Further, I understand that false or inaccurate information in this application will be the basis for termination.

Type Initials.

I understand that if employed, my employment will not be for any fixed period of time and may be terminated by the company at any time.

Type Initials.

I authorize and agree that I may be expected to work on a wide variety of job assignments in the Greater Sacramento Area and agree to accept assignments for which I am qualified as they become available. I understand that failure to report to Direct Placements , Inc. (8265 Sierra College Blvd # 304 Roseville, CA 95661) within 2 business days of an assignment being ended for any reason, will indicate that I have quit.

Type Initials.

If Direct Placements employs me, I agree to conform to the rules and regulations of Direct Placements I also understand and agree that, except for arbitration and employment at-will status, my wages, hours, working conditions, job assignments and compensation are subject to change by Direct Placements , Inc. I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of Direct Placements , Inc. or myself.

Type Initials.

My signature below certifies that I have read and understand this application, and to the best of my knowledge, the information I provided is true and correct. My signature below also certifies that I agree to be bound by the terms and conditions of employment stated in this application. This application contains all employment, if any, by Direct Placements and supersedes all prior and/or contemporaneous practices, oral or written agreements, understandings, representations and promises, express or implied, between me and Direct Placements , Inc.

Type full name to sign.

POLICIES AND PROCEDURES

1. I understand that Direct Placements takes their responsibility as my employer very seriously, and that they have gone to great lengths to provide a safe work environment. If I am injured on the job, Direct Placements will deal promptly with legitimate compensation insurance that will pay medical wages and expenses. I also understand that Direct Placements has extensive claims and has workers experience investigating claims and will fight fraudulent claims with all available resources.
2. If I sustain an injury on the job, I will inform the client and Direct Placements immediately; who will coordinate with myself and the client and myself the proper procedures for treatment and reporting of the accident.
3. Direct Placements has a strict substance abuse policy, and I have signed a consent form to submit to drug testing. I understand that my failure to comply with this agreement will be grounds for my immediate termination.
4. I understand and will comply with Direct Placements 's safety rules and regulations and hazardous communication program explained to me in Direct Placements 's orientation.
5. I understand that I am an employee of Direct Placements and only Direct Placements or I can terminate my employment. When an assignment ends I must report to Direct Placements for my next job assignment within three business days. Failure to do so or to accept my next job assignment will indicate that I have voluntarily quit and will not be eligible for unemployment benefits.
6. I understand that I am expected to complete any job assignment I accept. I understand that if I do not complete or promptly notify of my inability to complete the assignment, or if I do not report for my assignment then Direct Placements may assume that I have voluntarily quit and I will not be eligible for unemployment benefits. Failure to notify Direct Placements that I am unable to report to work is grounds for termination.
7. If for some unexpected reason, such as emergency or family illness, I cannot make it to work or will be late, I will contact Direct Placements prior to the beginning of my scheduled shift.
8. I understand Direct Placements 's requirements for receiving information, documenting hours worked, the method of providing this information, and the time frame for me to provide this information. I understand Direct Placements will not recognize or pay for any hours worked by an employee without proper documentation verifying hours worked.
9. I have read and fully understand the above statements regarding Direct Placements 's policies and procedures and agree to the same. I understand that failure to comply with these polices and procedures could lead to my termination and jeopardize my insurance benefits.

Please read each statement carefully and type initials indication that you have read and understand.

ACKNOWLEDGEMENT OF EMPLOYMENT

I understand that I am an employee of Direct Placements I am temporarily employed to work at a client of Direct Placements but that client is not my employer and my assignment there can end at any time. Should my assigment end for any reason, it is up to Direct Placements if they will put me in another assignment. It is my responsibility to call Direct Placements immediately after an assignment ends to find out about possible new assignments.

Type full name to sign.

GENERAL STAFETY RULES

Direct Placements has developed these safety rules patterned after the Federal OSHA requirements. Read and become familiar rules with these rules, and other safety rules that apply to your assignment.

1. 1. Report an injury to your employer and supervisor immediately.
2. Report any observed unsafe condition to your supervisor/employer.
3. Horseplay is prohibited at all times.
4.The drinking of alcoholic beverages is not permitted on the job.
5. If you do not have current First Aid Training, do not move or treat an injured person unless there is an immediate peril.
6. Appropriate clothing and footwear must be worn on the job at all times.
7. Where there exists the hazard of falling objects, an appropriate hardhat must be worn.
8. You should not perform any task unless you are trained to do so and are aware of the hazards associated with that task.
9. You may be assigned certain personal protective safety equipment. This equipment should be available for use on the job, maintained in good condition, and worn when required.
10. Learn safe work practices. When in doubt about performing a task safely, contact your supervisor for instruction and training.
11. The riding of a hoist hook, or on other equipment not designed for such purposes is prohibited at all times.
12. Never remove or bypass safety devices.
13. Do not approach operating machinery from the blind side; let the operator see you.
14. Learn where fire extinguishers and first aid kits are located.
15. Maintain a general condition of good housekeeping in all work areas at all times.
16. Obey all traffic regulations when operating vehicles on public highways.
17. When operating or riding in company vehicles or using your personal vehicle for business purposes, the vehicle's seatbelt shall be worn.
18. Be alert to hazards that could affect you and your fellow employees.
19. Obey safety signs and tags.
20. Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts and the ignoring of established safety rules is a leading cause of employee injury.
21. No employee shall lift, wrestle, or push any object or group of packages weighing more than 50lbs. without securing the assistance of at least one fellow worker.
22. Any employee with a contagious illness (other than a minor common cold) shall notify his/her employer/manager immediately.

I certify that I have read and understand and will be abide by the above listed safety rules. Failure to do so my be grounds for termination and may disqualify me for unemployment insurance benefits.

Type full name to sign.

SUBSTANCE ABUSE POLICY

It is the purpose of Direct Placements to help provide a drug free environment for our clients and our employees. With this goal and because of the serious drug abuse policy in today's workplace, we have established the following policy for existing and future employees of Direct Placements.
Direct Placements explicitly prohibits:
The use, possession, solicitation for or sale of narcotics or other illegal drugs, alcohol, or prescription medication without a prescription on companyor customer premises or while performing an assignment.
Being impaired or under the influence of legal or illegal drugs or alcohol off the company or customer premises that adversely affects the employee's work performance, his or her own or other's safety at the workplace, or the employers' reputation.
Direct Placements may drug test by three methods.
-Pre-Employment: As may be required by client.
-Randomly: A random selection of some employees for testing will be done unanounced.
-For Cause: When it is the company's belief that a drug problem exists.

Employees of Direct Placements who refuse to submit to drug testing, test positive, or admit to substance abuse will be terminated.

The result of all drug testing will be kept confidentially, and for no purppose other than for Direct Placements to make employment related decisions.

Type full name to sign.

If hired by Direct Placements, for every eight hour shift I will take a paid ten minute break before my unpaid thirty minute lunch break (which will be taken before the fifth hour of work). I will then take a second paid 10 minute break after my lunch prior to end of shift.

Type full name to sign

Authorization

I hereby certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Digital Signature

Indicates that you have read, understand, and agree to the Authorization statements above.

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